Fig. 32.—Bringing down the Olecranon with Figures of 8.
The splints and rollers should be removed on the fourth or fifth day, that the positions of the fragments may be examined and the roller again applied to draw them closer together. After ten or twelve days, passive motion of the wrist and fingers, with pronation and supination of the radius, should be adopted, but great care is to be taken that the patient does not inadvertently bend the elbow joint while free of the splint. The splint must be worn, with the frequent removals directed above, for five weeks, by which time gentle flexion of the elbow may be practised.
Hamilton notches his splint at each border about its middle so that the notches shall be 3 inches below the tip of the olecranon (see fig. 33). He begins the bandaging by fastening his splint on to the hand and forearm, as high as the notches; here the roller is carried above the olecranon and again down to the notches; this is repeated again and again, each turn below the last, until the notches are all covered, he then continues the bandage upwards by circular turns until the top of the splint is reached.
Fig. 33.—Hamilton’s Splint for fracture of Olecranon.
Fractures of the Humerus near the Elbow.—These resemble dislocations of the ulna and radius backwards, but are distinguished from them by the ease with which the bones slip into place and again slip back from it when left to themselves; by crepitus; and, when the fracture is above the condyles, the common accident, by those projections retaining their natural relation to the olecranon. In children and youths the articulating surface of the humerus may separate from the shaft without carrying the rest of the lower epiphysis with them. In this rare accident the main distinctions from the usual fracture are, the projection of the olecranon behind the condyles; from dislocation, the absence of the hollow of the sigmoid notch, and facility of reduction.
In ordinary cases, where the deformity is reduced without much difficulty, and the injury to the joint is not severe, lateral rectangular splints of leather, hollowed wood, or wire gauze, answer very well. These are placed both inside and outside the limb, and reach from the axilla and shoulder to the wrist. They are applied in the following manner:—
Apparatus.—1. Lateral hollowed angular splints.
2. Pads and wool.
3. Rollers 2 inches wide for the arm, and 1 inch wide for the fingers.